Stereotactic Body Radiation Therapy in Spinal Metastases.
Journal - International journal of radiation oncology, biology, physics
PURPOSE: Based on reports of safety and efficacy, stereotactic body radiotherapy (SBRT) for treatment of malignant spinal tumors was initiated at our institution. We report prospective results of this population at Mayo Clinic. MATERIALS AND METHODS: Between April 2008 and December 2010, 85 lesions in 66 patients were treated with SBRT for spinal metastases. Twenty-two lesions (25.8%) were treated for recurrence after prior radiotherapy (RT). The mean age of patients was 56.8 ± 13.4 years. Patients were treated to a median dose of 24 Gy (range, 10-40 Gy) in a median of three fractions (range, 1-5). Radiation was delivered with intensity-modulated radiotherapy (IMRT) and prescribed to cover 80% of the planning target volume (PTV) with organs at risk such as the spinal cord taking priority over PTV coverage. RESULTS: Tumor sites included 48, 22, 12, and 3 in the thoracic, lumbar, cervical, and sacral spine, respectively. The mean actuarial survival at 12 months was 52.2%. A total of 7 patients had both local and marginal failure, 1 patient experienced marginal but not local failure, and 1 patient had local failure only. Actuarial local control at 1 year was 83.3% and 91.2% in patients with and without prior RT. The median dose delivered to patients who experienced local/marginal failure was 24 Gy (range, 18-30 Gy) in a median of three fractions (range, 1-5). No cases of Grade 4 toxicity were reported. In 1 of 2 patients experiencing Grade 3 toxicity, SBRT was given after previous radiation. CONCLUSION: The results indicate SBRT to be an effective measure to achieve local control in spinal metastases. Toxicity of treatment was rare, including those previously irradiated. Our results appear comparable to previous reports analyzing spine SBRT. Further research is needed to determine optimum dose and fractionation to further improve local control and prevent toxicity.Copyright Â© 2012 Elsevier Inc. All rights reserved.
Brain natriuretic peptide in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): comparison with acute myocardial infarction.
Journal - Coronary artery disease
OBJECTIVES: Apical ballooning syndrome (ABS) is a transient cause of ventricular dysfunction. The aim of this study was to determine the clinical and hemodynamic correlates of brain natriuretic peptide (BNP) levels in ABS and compare the biomarker profiles in ABS with acute myocardial infarction controls. METHODS: Fifty-seven prospectively diagnosed patients with ABS whose BNP and troponin T level measurements were available were included. Fifty patients with ST-elevation myocardial infarction (STEMI) and 25 individuals with non-ST-elevation myocardial infarction (NSTEMI) were included as matched controls. RESULTS: In the ABS cohort, the BNP levels were higher in patients older than 65 years compared with younger individuals: 767 (269, 951) versus 340 (131, 904.5), P=0.019. There were no significant correlations between BNP levels and hemodynamic parameters such as left ventricular ejection fraction and end diastolic pressure. There were no correlations between BNP and peak troponin T (r=0.03, P=0.8). BNP levels were significantly higher in ABS patients when compared with the STEMI and NSTEMI controls. The BNP to peak troponin T ratio was significantly higher in ABS compared with the STEMI controls 1089.4 (446.7, 3334.8) versus 97.4 (17.9, 264.7), P=0.04. CONCLUSION: BNP elevation is almost universal in ABS. Cardiac hemodynamic indices do not correlate with BNP levels. The magnitude of BNP elevation is higher in ABS compared with STEMI and NSTEMI.
Clinical Outcome in the Use of Cephalosporins in Pediatric Patients with a History of Penicillin Allergy.
Journal - International archives of allergy and immunology
Background: The risk of cephalosporin administration in patients with a history of penicillin allergy is unclear. Few studies have looked at the risk of cephalosporin administration in children following penicillin skin testing for suspected penicillin allergy. The goal of this study was to determine whether children with penicillin allergy were at increased risk for adverse drug reactions when administered a cephalosporin. Methods: A retrospective chart review was conducted in pediatric patients (=18 years) with a history of penicillin allergy and a positive or negative penicillin skin test who were administered a cephalosporin after testing. Charts were reviewed for adverse drug reactions to the cephalosporin. Results: A total of 173 patients (91 males) were included in this study. The mean age of the patients was 4.1 ± 3.1 years. Twenty-one patients (12%) tested positive in a penicillin skin test and 152 patients (88%) tested negative. One patient with a negative penicillin skin test (0.7%) had an adverse drug reaction (eye swelling) to cephalexin. None of the patients with a positive penicillin skin test who received a course of cephalosporin had an adverse drug reaction. Conclusion: Among all patients with a history of penicillin allergy (penicillin skin test positive and negative), only 1 person had an adverse drug reaction. Further large prospective studies examining the safety of administering cephalosporins in pediatric patients with confirmed penicillin allergy are needed.Copyright © 2012 S. Karger AG, Basel.
Dexamethasone and postoperative bleeding risk after adenotonsillectomy in children.
Journal - The Laryngoscope (United States )
|ISSN : ||1531-4995|
|Mesh Heading : ||Antiemetics Child Child, Preschool Dexamethasone Female Humans Male Postoperative Hemorrhage Risk Factors epidemiology|
|Mesh Heading Relevant : ||Adenoidectomy Tonsillectomy adverse effects adverse effects chemically induced|
Host and Graft Thickness after Descemet Stripping Endothelial Keratoplasty for Fuchs Endothelial Dystrophy.
Journal - American journal of ophthalmology
PURPOSE: To determine relationships between vision, forward scatter, and total corneal and graft thicknesses after Descemet stripping endothelial keratoplasty (DSEK). DESIGN: Prospective, cohort study. METHODS: Forty-four eyes with Fuchs endothelial dystrophy were examined before and at 1, 3, 6, and 12 months after DSEK; all eyes were pseudophakic after surgery. Central total corneal and graft thicknesses were measured using confocal microscopy. Best-corrected high-contrast visual acuity (BCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study protocol, and forward light scatter was measured using a straylight meter. RESULTS: Total corneal thickness was 610 +/- 50 mum (mean +/- standard deviation) before DSEK, increased to 680 +/- 74 mum by 1 month after DSEK (P < .001), and stabilized at 660 +/- 68 mum by 3 months after DSEK (P = .03 vs 1 month). Graft thickness was 170 +/- 57 mum at 1 month, decreased to 157 +/- 49 mum by 3 months (P = .004), and then remained stable through 12 months (156 +/- 51 mum; P = .99 vs 3 months). BCVA was 0.44 +/- 0.21 logarithm of the minimal angle of resolution (logMAR) units (Snellen equivalent, 20/55) before DSEK, improved to 0.26 +/- 0.20 logMAR units (Snellen equivalent, 20/36) by 3 months (P < .001), and improved to 0.16 +/- 0.16 logMAR units (Snellen equivalent, 20/29) at 12 months (P < .001 vs 3 months). BCVA and forward light scatter did not correlate with corneal or graft thickness after DSEK. CONCLUSIONS: Stromal edema resolves by 3 months after DSEK for Fuchs dystrophy, whereas visual acuity continues to improve through 12 months. Thicker corneas and grafts are not associated with worse visual acuity or increased forward scatter.Copyright © 2010 Elsevier Inc. All rights reserved.